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�'"'"_� APPLICATION FOR BLIND OR DISABLED PERSON'S
. _ �DEDUCTION FROMASSESSED VALUATION
i• �• . State Form a3710 (R4 / 70-0i)
S:"� Prescnbetl by �he Department of Local Govemment Finance
I COUNTY � TOWNSHIP � YEAR
I (
��- �mation contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 6-1.1-72-72(b). File Mark
RUCTIONS: �� �}�-�
To be filed in person or by mail with the County Auditor oI the county where the pioperty is locat��lrl ��� C A
Filing Dafes: 1) Real Property: During the 12 months be%re May 11 0l the year the deduction is � be a �y
2) Mobile Homes assessedLnderlC 6-1.1-7: Behveen January 15 and March 31 0l the yMa�rY e deduc6on is to be effective.
See reverse side for additional instructions and quafifications. 2 2002
Name
�Yes
If name on record is difterent tha that
Name of contract seller
l.�
4ddress ofcontra eiler
Is appliqnt biind as defined in IC 12-1�
❑ Yes
�
what is his/her ezact share of interest?
❑ No �
applicant, indicate below
�
❑ No
GIBSON C°OU�JTY e
If owned with someone
indicate with whom
Is the property in question:
spouse,
I❑ Real PropeAy ❑ Mobile Home (IC Fr1.1-
Is appliwnt disabled and unable to engage in any substantial gainful activity
as defined in IC E7.1-12(d)?
[�'es ❑ No
Does the applicant's taxable gross income for the preceding calendar year
exceed 577,000?
�Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
of applicant
ot applipnt
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